The “Cash-less” facilities offered by some companies do not benefit the Doctors working in an empaneled hospital as well.

I know of 1 case where a patient had visited an Ophthalmologist to do cataract surgery for his second eye, but the Doctor was yet to receive payment from the TPA for the first surgery on the same patient done 3 years ago !!

Medical Insurance: why Indians SHOULD NOT like it

it is a scam directly imported from US. Gone are those days where you can go in to any hospital and get treated for anything.

now you don’t know whether 1) your megalomania personalfinancitis is covered in your policy first of all 2) is not pre-existing 3) the hospital will endorse your “half indian-half foreign” medical insurance 4) so on and so forth.

even the greedy /dumb americans know they CANNOT AFFORD to be sick and they go abroad to have a simple hernia procedure

Quote found on a claims adjuster’s desk:

If you are healthy you do not need it;
If you are sick it is not covered

Prosecution rests.

“client confidentiality restrictions”: good enough reason for me to not buy a medical policy.

subra, I never knew that a medical insurance can keep your mind calm! My mind, on the other hand, calmed down only after I accepted my mortality. P.S. My method is cheaper.

If the hospital knows that you will be paying through insurance then they will add unnecessary items and will inflate the billl.
Then the insurance company will say these are non essential things and not covered in Policy and will provide a very reduced amount and not the whole bill. Also the Amount of Co-pay is very high for many insurance companies.

The Hospital will not give discharge unless the Insurance co. clears the bill or you pay upfront. I faced this issue once and decided to pay in full to hospital and then fought with the insurance company. Thankfully i got the complete money reimbursed but had to fight a lot for this.

So medical insurance is surely horrible In India. I dont know about US but may be it is the same over there

Health policy is required for young people as they do not have the necessary corpus or in the process of creating the wealth for future. Untimely health related cost can hamper this process. I fully agree that the fate of claim is in the hands of underwriters and one may get only 40-60% of claim. One problem solution is start a sip for health fund in later age. Cover your early years with health insurance. Read sections like exclusions, Preexisting diseases coverage and day care procedures carefully before signing.

I had STAR Health insurance for my father for 2 lakhs. He under went angioplasty and the bill came to about 2.5 lakhs. The insurance paid the full amount of 2 lakhs through cashless facility.

I was surprised but happy.

Now a days hospital have packages for child birth. When we asked in reputed hospital (recently opened in collaboration with a Multinational co) in Bangalore, package was priced at 75k for non insured person. While admitting as cashless(insured) option estimate was given for 53K on insurance paper. Bill came for around 51K. I paid my co-pay of 20% and later insurer took another 10% discount and paid hospital only 36K. So for listed package of 75K hospital received only 46K ~40% discount.

Can you we have uniform pricing or atmost 10% difference. Why should non-insured person pay more?

My wife recently had a surgery at a prominent hospital in South Mumbai. The surgery cost for single room customers was negotiable directly with doctors which of course noone informs you lest you actually use the option. Next, doctors will visit you unnecessarily to extract maximum visiting charges from the insurance company.Thirdly unnecessary tests will be done upon you which are not even related to the problem. And then, you prey that your deductions are kept to a minimum. Of course if it is a corporate policy, you have better chances of getting higher refunds.

Worst thing is that change in class of room makes obnoxious change in all other charges along with change in room charges. So for the same surgery, depending on my room class, my total cost would be anywhere between Rs.65,000 to 3lakhs depending on my room type.

My experience with Medical insurance claim is ok.
– First I used it during delivery of my child. The hospital had a package for pregnancy and insurance had a limit on pregnancy charges. The bill came much higher than insurance limit and insurance company happily paid their full limit that too cashless facility (50K limit).
I came to know from above experience (my first) that hospitals try to extract as much money as possible from you.
– So next time for hospitalization, I did not opt for cashless and told the hospital that I don’t have any insurance and then bargained. I got lessor rates and later I claimed the amount from insurance. Since I took care of room rent etc (meaning ensured that they were in limits), insurance paid all amount less my co-pay. (10K bill, 1K co-pay and 9K reimbursed by insurance)
– Third time also I told hospital that i will be paying my own and then bargained. Once I settled for an amount, I said now I will go for cashless. Surprisingly, they increased the amount and were not ready to give earlier package in cashless!!
I opted for cashless and for a 51K operation, had to pay 6K from my own pocket despite no provision of co-pay.

In my experience insurance companies were ok, it is the hospitals who were the culprit. They want to inflate the bill as much as they can. Insurance companies obviously don’t want to spend that much and thats where all the disputes arrive.

I have seen in hospitals, doctors/staff says “Are yaar! you are covered under medical insurance. Why do you bother what is the bill” and a lot of people fall for it. This artificially inflates medical costs, then insurance companies increase their premium and we as consumers then complain. Think about the guy who doesn’t have insurance, he/she is the one totally screwed in this situation.